An exploration of the discourse of health in learning disability nursing textbooks in the post 'continuing the commitment' era.

The aim of is study was to conduct an exploration of the emergent discourse of health in learning disability nursing textbooks in the era after the publication of 'Continuing the Commitment' (Doh 1995). The method used is an adaptation of discourse analysis involving three distinct stages - 'description'; 'interpretation'; and 'explanation'. The data analysed consists of five chapters focussing specifically on 'health', in four learning disability nursing textbooks published between 1997 and 2003. The first stage of 'description' involved description of the textbooks in which the texts are situated, and of the texts themselves, and the identification of common themes across the texts. Three main themes emerged:- 1) The identification of a holistic and humanistic model of health as the most appropriate in relation to people with learning disabilities. 2) The problematisation of health as an issue of the vulnerability of people with learning disabilities to the development of health problems. 3) The problematisation of the standard of generic healthcare services in understanding and meeting the health needs of people with learning disabilities. Stage two of analysis involved identifying 'interpretative repertoires' in the texts, exploring in particular how these are used to construct the 'facticity' of the themes identified in stage one. The third stage of analysis focused on exploring the relationship between the emergence of the discourse of health and ideological and policy developments in the UK welfare state. In conclusion the analysis is discussed in relation to critical theories of the caring professions. It is argued that the emergent discourse of health represents part of an attempt to reconstruct the role and identity of learning disability nursing in response to material and structural pressures, whilst struggling to maintain congruence with the ideals of the profession. The need to resist the 're-pathologisation' of learning disability by 'biologisation' of learning disability itself is highlighted, and the need to develop a dialogue with people with learning disabilities about their health and healthcare needs is advanced as one among the strategies needed to avoid this